Therapies for Ailments in Eighteenth-century Scotland

14 Pages·2004·0.05 MB·English

Proc. R. Coll. Physicians Edinb. 1998; 2222288888:::::555-568
THERAPIES FOR MENTAL AILMENTS IN EIGHTEENTH-CENTURY
SCOTLAND
R. A. Houston, Department of Modern History, University of St Andrews
Most studies of early-modern therapeutic regimens are based on prescriptive literature
or medical case-notes kept by medical practitioners.1 In order to understand more
fully what was done for sufferers from mental conditions it is essential to go beyond
these potentially limiting sources. Some 600 statements of witnesses have been
examined, drawn from Sheriff Court, Court of Session, and High Court of Justiciary
cases where the mental capacity of an individual was questioned. Those with knowledge
of a person’s behaviour testified in court, giving examples of speech and behaviour to
prove or disprove that they were ‘fatuous’ or ‘furious’ - the then principal legal categories.
Their testimonies frequently described aspects of the sufferer’s life over months or
years, including any attempts to cure their condition. Approximately a fifth of witnesses
were medical practitioners - physicians, surgeons, and apothecaries - but the remainder
were laypeople from a wide variety of backgrounds. To these, information derived
from asylum admission petitions, again mostly written by layrelatives of a deranged
person, was added. Sufferers were generally diagnosed as suffering from ‘madness’, or
from some more precise condition such as ‘melancholia’ or ‘hypochondria’ (then a
significant psychosomatic ailment).
What these documents show is that what physicians administered by way of treatment
was often the outcome of a process of negotiation with patients and their relatives.
They also demonstrate the importance of self-therapy and of the ‘medical market
place’. Professional, quasi-professional, or laykeepers and carers generally tried, or
presided over, some form of medical treatment. Their efforts, brief or prolonged, to
alleviate or cure symptoms covered the whole range of traditional and modern medical
theory and practice.2 To the mainstream approaches - primarily the application of
counter-irritants and evacuants - were added water cures, shocks, and a variety of less
common but still well-known remedies. In the case of mental ailments, the significance
of psychological as well as medical therapy, including the enduring importance of
religion as an aid to recovery, must also be recognised.
What follows is not a systematic investigation of all types of care or cure but a
qualitative analysis of the regimens and treatments used on those who appear in our
civil and criminal court population and among asylum papers. The sources used have
the merit of allowing us to look at the changing relationship between medical and
other types of therapy, at the process of decision-making in day-to-day interactions
between healers and sufferers, and at the place of self-therapy.
HUMOURS AND NERVES: CONTINUITY AND CHANGE
A formidable array of remedies was available to sufferers. These included evacuations,
blood-letting, cathartics, purgatives, emetics, blistering agents, camphor, opium, warm
and cold bathing, mercury, anti-spasmodics, belladonna, and digitalis.3 Most of these
derived from the tradition of heroic therapeutics and and were an attempt to restore
the balance of ‘humours’ in the body. Galenic theory, which derived from the classical
*Professor of Early Modern History.
555
556 R. A. HOUSTON
age, held that vital forces must be kept in equilibrium. If fluids in the body, of which
blood was just one, got out of balance then the body might become too hot or cold,
too wet or dry.4 For example, blisters were intended to relieve the brain of ‘morbid
suppurations’ while cold baths and bleedings helped ‘cool’ the body.
A routine treatment for all sorts of ailments will be considered first. Bleeding is
occasionally mentioned as having a sedative effect on the ‘furious’. James Mackie,
porter to a Glasgow spirit dealer, saw William Young in church, ‘restless and uneasy
and shifting about in his seat and appeared to be absent in his mind’. Later he saw him
in bed, ‘calm having been newly bled’.5 A more extreme case involved David, Lord
Halkerton. Subject to ‘furious’, and on one occasion murderous, fits, Halkerton became
the subject of a tussle between his mother and a cousin in 1709. Anxious to show her
son was recovering, Lady Halkerton ‘has put him in the hands of a pitiful cow-herd of
a mountebank who has by extravagant bleedings brought his body to that degree of
weakness that he is hardly able to walk, which could not but abate his former fury and
heat, but as to his judgement it is much the same as ever’.6 This last statement came
from the cousin and was remarkable even by the standards of the tendentious and
hyperbolic ‘informations’ and ‘answers’ which the Lords of Session had to hear. Yet,
it fits the pattern of treatment which are known from other sources to have been
conventionally meted out to the ‘furious’.
Therapeutic regimens of the later eighteenth century were based to some extent
on the new orthodoxy about the origin of diseases which was beginning to take over
from Renaissance humoralism. Fashionable physicians of the period espoused the
notion that it was all in the nerves. Robert Whytt’s promotion of nervous physiology
from the 1740s was a landmark in medical thought. The essence of the physiological
side of the theory is nowhere more clearly expounded than in a 1780s advertisement
for Dr Alexander Monro’s Observations of the structure and functions of the nervous system.
What has obtained the denomination of the Nervous System is known to be that
medium which is interposed between the living principle and the different organs of
which the bodies of animals are composed. The nerves are the instruments of sensation,
and it is by their influence that all animal action is performed; they are the source of
feeling, and they prompt all our propensities, instincts, and movements. Hence a
knowledge of their structure, distribution, and functions must be extremely important,
both to the philosopher and the physician, in the study of nature.7
Dr William Cullen proposed that diseases were often caused by having a surfeit or
deficit of nervous tone: a ‘neurosis’. If this theory was to become dominant, traditional
interpretations of illness and methods of cure retained their hold even at the end of the
eighteenth century. The managers of Glasgow Asylum stressed moral therapy in their
public communications but the institutional practitioners’ case-notes suggest that
traditional methods such as restraint, bleeding, and purgation were still extensively
used in the early years.8
Conventional medical wisdom had it that restricting the freedom of action of a
manic person was likely to be therapeutic as well as practical i.e. for safety reasons. A
former shipmate told how Robert Spence was lashed to a post or chained below decks
during ‘furious’ phases on board during Captain Anson’s lengthy expedition, concluding:
‘the wholesome discipline he met with...contributed in some degree to depress the
effects of this distemper’.9 William Cullen’s treatment regimens for both maniacs and
melancholics involved restraint, a measure whose medical value was still accepted in
the 1810s and beyond.10 Going against the developing therapies of moral management,
THERAPIES FOR MENTAL AILMENTS IN EIGHTEENTH-CENTURY SCOTLAND 557
Cullen’s view that mental disorder was a function of ‘lesions in our judging faculty’
invited the coercion of the patient.11 In cases of mania: ‘Restraint...is useful, and
ought to be complete; but it should be executed in the easiest manner possible for the
patient, and the strait waistcoat answers every purpose’.12 Using other people for
restraint ‘is often hurtful’ because it causes struggles. ‘The restraint mentioned requires
confinement within doors, and it should be in a place which presents as few objects of
sight and hearing as possible; and particularly, it should be removed from the objects
that the patient was formerly acquainted with, as these would more readily call up
ideas and their various associations.’13 Furthermore, confinement of patients should
not be ‘in their usual habitation’ and the patient should be kept away from ‘the company
of any of their former acquaintance; the appearance of whom commonly excites
emotions that increase the disease’.14 Maniacs should be kept in a state of awe or fear,
especially of those usually with them. Awe and dread may have to be cultivated by
force, including ‘stripes and blows’.15 It was also a good idea to restrain melancholics
‘from pursuing the objects of their false imagination’ but not to the extent needed
with ‘the impetuous and angry mania. It will be generally sufficient to acquire some
awe over them...to check the rambling of their imagination, and incoherency of
judgement’.16 Later, in England, George Man Burrows was among the more prominent
advocates of somatic not moral diagnosis and treatment.
Of course, this was not an orthodoxy. Dr William Buchan had argued trenchantly
against restraint for melancholics. A proper regimen of diet, amusement and exercise
‘would be a more rational method of cure than confining the patient in Bedlam, or
sending him to a private madhouse. These institutions, as they are generally managed,
are far more likely to make a wise man mad than to restore a madman to his senses.’17
In the early nineteenth century, Cullen’s views on restraint were certainly not accepted
by those charged with investigating madhouses. The general observations on the shire
of Edinburgh made by the nominees of the Sheriff in 1816 drew attention to the
insecure nature of many private madhouses and the low ratio of staff to patients: ‘the
keepers received too many patients, considering the nature of the accommodation
they possess, and the number of under-keepers they employ’.18 Sheriff’s reporters also
recognised that long-term restraint was partly a response to the fear that patients would
escape rather than because they were chronically ‘furious’. At Mrs Bourhill’s, Cottage
Lane, Musselburgh, four patients from the eleven of this establishment were chained,
including a man ‘who seemed perfectly quiet and good-natured’ simply because he
had tried to escape.19 At Thomas Cathy’s ‘a young woman fatuitous and pale, probably
much confined to a very small room, not provided with any means of ventilation.
When the door of this apartment was opened she instantly and in haste escaped from
it like a dog from a kennel. She appeared afterwards quiet and manageable.’20 Seclusion
here was a punishment or a way of reducing the time keepers needed to spend on a
patient. Sheriffs (or Sheriffs-Depute) tried, where appropriate, to reduce the use of
restraint in licensed private madhouses and between the twice-yearly visits in 1815-16
reported that its incidence had declined.
Sheriffs-Depute and their medical advisers sought to restrict confinement or restraint
whose cause was laziness or vindictiveness on the part of keepers. That does not mean
they wholly discountenanced therapeutic confinement of short duration, though their
leanings were clearly towards moral therapy. Nor was it unacceptable to bind or lock
up a man who presented a threat to himself or the ‘lieges’. Everyone seems to have
accepted the need for such restraint in the interests of patients and public, and in many
cases it is difficult to see what other steps could have been taken. John McCormack
558 R. A. HOUSTON
was the eldest son of the late William McCormack of Upper Merryflats in the parish
of Meikle Govan near Glasgow. He was prone to bouts of outrageous behaviour and
a neighbouring farmer told how one day he had seen John running down the road
hotly pursued by his father and brothers. Just prior to his cognition the family surgeon
found him:
in a ‘furious’ state and quite insane and that he had cut his throat with some sharp
instrument. That the deponent sewed up the wound and when he visited him the
following day he found that the sewing and bandages about it were torn away and
the deponent was told that the said John McCormack had done it himself...that from
his outrage it was judged expedient to tie and put him under confinement.21
The better-off could afford servants to attend an unpredictable relative 24 hours a
day and to employ one or two strong men to accompany them on their walks in town.
Reformers criticised restraint on the grounds of ignorance or laziness whereas they
may more accurately be attributed to poverty and a lack of resources - as Sheriffs-
Depute understood. If some sufferers needed confinement and restraint, others were
thought to require space and freedom. A change of scene was part of conventional
wisdom about improving mental health. Sea voyages, visits to the country, changes of
asylum, moves into or out of madhouses - all were tried on patients of means. Some
patients had the appearance of dedicated travellers. In his late teens Thomas Holmes
suffered a ‘severe nervous fever’ as a result of which ‘he became dejected and entertained
a very unfavourable opinion of his own abilities - thought he could do nothing correctly’.
He took to bed for weeks at a time and seldom spoke. Recommended to take a
voyage to Lisbon, he returned apparently much better but soon relapsed. Four or five
years later, in autumn 1805, he went with a brother to Jamaica but had to return in the
summer of 1811.22 Apart from removing stressful stimuli, voyages may have had other
functions. Many sea travellers would have suffered from seasickness, a condition which
would prevent them from dwelling too much on other anxious or gloomy thoughts.
A similar idea lay behind the use at Glasgow asylum from 1819 of a ‘rotating or
whirling chair’.23 Patients were suspended above the ground in a chair turned on a
pivot until they became nauseated and thus pacified. The chair seems to have had
both a therapeutic and punitive function.
This was an age of scientific advance and medical optimism. For all that, practitioners
recognised the limits of their art. Scottish physicians of the eighteenth century seem
generally to have tried their best for a patient and then given up. Dr James Gordon of
Pitlurg treated Jean Bannerman from May 1746 because she had ‘for some time before
been afflicted with a melancholic disorder which affected much her health, spirit and
senses’. He found ‘the disease...pretty far gone’, but her health was improved by his
applying external and internal medicine. After attending her for nearly a year ‘he
found the disease a continued and fixed melancholic madness with little or no lucid
intervals’, and pronounced ‘he could be of no manner of service’, though he did later
advise on ‘her diet and method of management’.24 Patrick Nisbet, surgeon in Perth,
gave Elizabeth Nairne ‘several medicines’ for her derangement but all proved ineffectual.
In the three weeks before she went to Edinburgh Infirmary he stopped visiting her ‘as
he thought it to no purpose, and as her disorder seemed to him incurable’.25 Even in
the early nineteenth century, medical treatments were far from ubiquitous. Medicine
was seldom used at the Spittal Asylum (Aberdeen) because the inmates were idiots and
imbeciles assumed to suffer congenital defects. Even among the 50 patients in Montrose
Asylum in 1818 (mostly of some years standing), four-fifths were not given medicine
THERAPIES FOR MENTAL AILMENTS IN EIGHTEENTH-CENTURY SCOTLAND 559
at all and the other 20% were exclusively prescribed laxatives.26 At the prestigious
York Retreat in England, physicians had recognised how much was to be done by
moral, and how little by any known medical means.27 We shall deal with the ‘moral
management’ shortly.
CHOICE OF REGIMEN
The physician or surgeon was generally working with, but not for, the mental patient.
Caring for the insane was in a way similar to treating children where parents or guardians
would call in the doctor, negotiate treatment, and pay the bill. The merely ill generally
sought medical help by themselves, whereas the mentally ill usually became the subject
of medical attention initiated by others. Doctors sometimes stumbled on people who
thought that perfectly healthy parts of their body needed to be cut off or who believed
without apparent justification that they were being poisoned. Samuel Clark, surgeon
in Glasgow, visited William Young on 14 May 1815 and found him ‘very incoherent’.
Clark would only have been in his early or mid-twenties at this time and perhaps a
little cautious and unsure. Since he had ‘not been called upon to make a report of his
situation he did not so particularly attend to him’.28 Clark proceeded to a routine
bleeding and it was only when the patient asked to be allowed to bleed to death that
he began to pay attention to his sanity. In this case and most others, practitioners came
at the behest of a relative or at the patient’s request to attend to a physical ailment. If
the ‘client’ was not the family, he was an official. Peter Rolland told how he had
visited Janet Brown with another surgeon ‘in consequence of an order from the Sheriff’.29
Physicians and surgeons had limited sovereignty in the medical regimens prescribed,
for the patient’s ‘friends’ (close and extended family) ultimately retained control. Medical
practitioners were employed like clerks and teachers, clients being prepared to challenge
a man’s diagnoses and decisions - or even to go elsewhere if dissatisfied. As Rosner
notes, successful practitioners needed an ‘easy, obliging and attentive manner’.30
Georgian doctors naturally understood the relationship. In discussing hypochondriac
patients, Cullen observed that they frequently changed their doctor ‘for a physician
who does not admit the reality of the disease, cannot be supposed to take much pains
to cure it, or to avert the danger of which he entertains no apprehension’.31 Dr John
Rutherford, an ageing Edinburgh physician, told the inquest on Michael Potter how
‘he some little time ago received a card from some of Mr Potter’s relations desiring
that he would prescribe bathing in the sea which the deponent did rather to satisfy the
persons who had desired this than from any expectation that it would have success.’32
Treatments were not simply dictated by doctors but were influenced by fashion and
the central role which patients or their relatives had in choosing a medical regimen.
Bathing was certainly a fashionable cure for all sorts of ailments. Doctors William
Buchan and William Cullen discoursed on the merits of cold and warm bathing for
maniacs and other sufferers of nervous diseases. ‘Bagnios’ or bathhouses were in
existence before the Restoration. The first known bathhouse was opened in the
1650s at Leith, and bathing was an established part of the medical regimen by the
1700s when the principal city bathhouse with hot water was run by the surgeons.33 A
‘table of the prices of provisions’ in Hugo Arnot’s History includes an entry for 1705:
‘use of the cold bath per half-year’ £2 sterling. A hot bath on one’s own would cost
the huge sum of ten shillings but only five shillings if shared; a cold bath was four
shillings. A footnote reads: ‘The bath belonged to the company of surgeons. We may,
therefore, rest assured that the hot or cold baths were then prescribed for all diseases’.34
The Royal College of Physicians ran a cold tub at St Michael’s Well in the Cowgate.
560 R. A. HOUSTON
Season tickets were available but business was never particularly good, even for the
hot baths, and the surgeons’ bagnio was stripped of its marble, tiles and fittings during
the 1730s.35 In 1735 John Douglas, architect, proposed building another one at the
foot of Carruber’s Close - a street which also contained a dancing school and other
diversions.36
The fashionable people who frequented Carruber’s Close would surely have been
able to gloss as a superstition the belief in the healing power of water and wells. Yet
examples of immersion in water or drinking it, both accompanied by suitable rituals,
were collected by Mitchell from newspapers and oral testimony referring to the north
and west of Scotland up to the early nineteenth century. In particular, a shrine on the
island of Innis in Loch Maree was said to possess a power ‘unspeakable in cases of
lunacy’.37 Mitchell presented such beliefs as ‘superstitions’ believed to help lunatics,
though throughout his article many of the examples cited relate to the attempted cure
of epileptics.38 Campbell too cited examples of the power of water to cure madness.
These included the ruined chapel at Clachan next to the River Tay at Strathfillan (near
Tyndrum) where a ritual involving immersion was performed.39
This was used by one father of a ‘furious’ son. John McLauchlane younger of
Auchintroig started behaving wildly in March of 1733. In May ‘he was carried to the
Strathfillan Well for cure where madmen were carried’ or, as another deponent put it,
‘as a man discomposed in his thoughts’. While there, James McFeat and others ‘put
and tied him in the kirk or chapel all night where mad men use to be put and when
they washed him in Strathfillan Well and dooked him therein he behaved very civilly
and complied with all they did’.40 Strathfillan was a holy well held to be particularly
efficacious at that time of year. In the evening, sufferers were instructed to bring up
three stones from the bottom of the pool, then walk three times round each of the
three cairns on the bank, placing a stone on each. They were then tied on to a stone
‘bed’ in the adjacent chapel overnight.41 Significantly, it was not until June that Dr
Brisbane from Glasgow was called in to look at John.42
RELIGION AND PSYCHOLOGICAL HEALING
Practices like this were increasingly written off as superstitious during the eighteenth
century. If magical remedies were becoming less acceptable, mainstream religious
ones were available throughout our period. Moral therapy ‘was not so much a specific
technique as a range of non-medical treatments designed to involve the patient actively
in his recovery.43 It was a tendency within treatment rather than a specific regimen,
taking account of the patient’s sensibilities and reactions. The emphasis was on rational
and emotional rather than organic causes, and a range of non-medical techniques
which involved the patient in his or her own recovery. Excessive constraint and
domination of the patient was replaced by more ‘humane’, interactive therapies, which
stressed the emotional aspects of care.44 Self-control rather than external restraint was
at the heart of moral management, which was ‘directed to the mind and character of
the sufferer, engaging his attention, gaining his respect, breaking evil habits and
associations’.45 Of course, the borderline between coercion and co-operation may
have been blurred in practice.46
From medical practitioners is derived a picture of interrogation and of gentle but
insistent (sometimes impatient) confrontation with the lunatic. This was not merely a
crude exercise of power, but was designed to help the patient to regain his or her
standing as an independent moral agent rather than an involuntary actor. Andrew
Wardrop, a surgeon in Edinburgh, spoke of his visits to John Hay of Paris while he was
THERAPIES FOR MENTAL AILMENTS IN EIGHTEENTH-CENTURY SCOTLAND 561
incarcerated at Saughtonhall private madhouse. He remarked on how John Hay
‘sometimes shows an unreasonable suspicion of him’. Wardrop agreed that ‘it is natural
for a person who is confined on supposition of derangement to be suspicious of those
who visit him’ but said he had tried strenuously to persuade John Hay ‘that he did not
visit him with any intention to injure him or to have him detained there unjustly.
That it was in Mr Hay’s interest to prove by his conversations that he was not deranged
and the deponent is of the opinion that if Mr Hay had not been deranged he would
have been convinced by the deponent’s reasons and would have laid aside his
suspicions’.47 Among other things, Wardrop wanted Hay to acknowledge that his
father was dead, a simple fact of which everyone else was aware. Of course, the aim
remained ultimately to re-establish social conformity in the patient just as traditional
therapies had done - and were still employed to do even in the early nineteenth
century.48
‘Modern’ methods of care such as moral management included the use of religion
as an aid to self-control. In some ways, this was merely an extension of the traditional
role which faith had played in healing. Part of Margaret Crawford’s delusional world
of the 1720s and 1730s featured spirits and demons. As mediated through those around,
her understanding of her condition was antipathetic to the godly state of mind prescribed
in devotional literature.49 Thus, her cousin Alexander Livingston advised her to
compose herself by reading the Bible, a path conventionally laid out for those who
wished to find their way from spiritual turmoil. God’s word was the voice of sanity.
For Margaret Crawford that avenue was closed off because she believed that her Bible
was ‘charmed’ or had a spell on it.
Others regarded the word of God as a bridge back to sanity for those who had
crossed into madness. When Alexander Goldie’s business partner was worried he
might kill himself, he used a religious homily to warn him of the heinousness of self-
murder’.50 Close introspection which lead to faith and repentance, coupled with
immersion in the Scriptures, had long been a Calvinist cure for all sorts of ills. Hugh
Maxwell of Halkerston was visited at the Edinburgh Bedlam by Mr Moncrieff, minister
at Redgorton. He brought with him a Bible ‘to try if he could read and get some of
the psalms by heart and Mr Moncrieff promised he should get out if he did’. George
Steill, keeper of the Bedlam, saw Hugh Maxwell appearing to read the Bible at various
times ‘but the deponent never heard him read’. Later he found the leaves of the Bible
cut out and hidden under the bed.51
Being in church was itself supposed to calm people, just as reading the word of
God was held to be a way of restoring sanity. Where medical practitioners confronted
the insane with observable reality and conventional wisdom, clergy sometimes tried to
use a spiritual level of analysis and cure. When the healing power of God’s word was
effectively blocked by lack of reason a person’s situation was truly parlous. When the
minister of Airth visited George Thomson in October 1817 he thought him deranged
and ‘deemed him in such a state as no clergyman should attempt to offer him religious
admonition’.52 With their continued emphasis on prayer and fasting, Scottish clergy
provided a source of psychological healing throughout the period.53
In terms of institutional presence in early nineteenth century asylums, the religious
profession was as well-represented as the medical. Throughout the eighteenth century
medical and spiritual intervention went hand in hand. Early-modern men and women
saw clergy far more commonly than they did doctors. A minister was easier and
cheaper to consult, and was a more likely first resort of those who were troubled in
mind. Charity workhouses and early specialist asylums were as likely to have resident
562 R. A. HOUSTON
chaplains as resident doctors. Glasgow asylum had religious services from 1819, and
even before that individual patients might be visited by clergy or allowed out to attend
church in the city.54 A chaplain was appointed in 1823. According to one’s point of
view, exposure to religion could exacerbate or alleviate religious melancholy. It could
do the same for ‘furious’ patients.55 Some argued that certain types of participation, or
certain messages, could agitate rather than palliate or uplift.56 Some claimed that inmates
should not be allowed to worship publicly, but that instruction should be given to
them in private.
Whatever the emphasis, among those providing care in public institutions, religion
was broadly accepted as a part of moral therapy, the debates being about ‘how, when,
and to whom, religious instruction should be imparted’.57 The most sophisticated
analysis was that some people already so predisposed would have mental illnesses
triggered by religious inputs and that such people were likely to demonstrate insanity
in religious ways.58 The acutely ill could not be allowed to attend but for those on the
mend the benefits were clear. It was claimed in 1818 that a patient suffering from
‘religious melancholy’ was brought back from the brink of suicide by a suitably delivered
biblical text.59 With any direct benefit of attending services went the psychological
boost to patients of being allowed to participate in a central social institution from
which they had previously been excluded because of their ‘furious’ behaviour. If
behaving badly in church had been a sign of derangement or stupidity, being allowed
to worship was a reward and a possible bridge back to ordinary life.60
Very broadly defined, the goals of modern psychiatry are to relieve symptoms,
support the patient, help him or her to ‘find themselves’, and help them adapt to the
needs of society. Conversely, ‘the concept of a “normal” person... implies a mental
condition of creative self-fulfilment, a productive attitude towards life, gratifying
relationships with people, etc.’61 Eighteenth-century practitioners concerned with
mental illness or incapacity concentrated on relieving symptoms and socializing the
patient, focusing hardly at all on the promotion of self-identity or realisation. The
scope of treatment was firmly determined by cultural expectations which placed the
greatest emphasis on outward conformity and contribution to the family and wider
society. Patients were not being helped to find themselves but to rediscover their
place in the social fabric. This was an age in which people were only beginning to
define themselves as individuals. Family, community, and society took priority over
the individual and many of the rights modern observers assume he or she might have
had. Just as definitions of insanity were partly tied up in a person’s place within a
network of social relationships, so criteria of the efficacy of therapy were predicated
on culturally distinctive concepts of social utility. On 11 March 1777 John Philip’s
brother William, a merchant in Edinburgh, petitioned to have him moved from the
tolbooth to a Bedlam cell. John, he claimed, was getting worse in the common jail
and should be removed to a place ‘where quiet, privacy, and proper care may give the
unfortunate sufferer a chance of recovering his distracted senses, of becoming again an
object of trial [fit to stand trial]...and of being again restored to his friends and to
society’.62 A newspaper advertisement of 1800 defined a desirable outcome for the
mental patient as: ‘being restored to health, and to the society of his friends’.63
Indeed, medical treatment was only part of the equation. William Somervell seems
to have suffered from a communication failure which caused him to become increasingly
isolated from those around him. His mother and those employed to help him aimed
to restore his ability to interact but more obviously to assist him in conforming to
certain elements of the social context. For example, Britain was at war during the
THERAPIES FOR MENTAL AILMENTS IN EIGHTEENTH-CENTURY SCOTLAND 563
1790s and 1800s. Many of those who appeared as claimants or subjects before the
Sheriff Court were styled ‘captain’ or ‘lieutenant’, meaning they were either serving
or reserve officers - Janet Somervell’s late husband for one. Donald McDonald, officer
of the Highland Society, was employed for 14 months to teach William Somervell ‘to
walk properly he being a cripple and having no ability in his hands’. After two months
he claimed some success in teaching him to march, to hold a knife and fork, to fire a
pistol and musket, to shoulder a musket and to present arms.64 Carers valued passivity
in a patient for this indicated malleability, educability, and the possibility of restoring
obedience to social norms. MacDonald spoke approvingly of how biddable Somervell
was. Communicating with and securing the co-operation of the patient was not an
issue outside moral therapy.
While these emphases may seem archaic to modern readers, it is plain that the
relatives of the insane themselves wanted little more than a return to behavioural
conformity. The ageing cottar employed to look after Neil Campbell of Dunstaffnage
recounted how ‘in harvest last it was found necessary to tie him with cords for a night
or part of a night’ but went on approvingly to inform the inquest that since Martinmas
Neil had been ‘low spirited but peaceably and inoffensively’.65 While he might still
walk naked around his castle and talk to himself, Neil was not currently a problem for
those around him. In so far as they acknowledged their condition, the mentally troubled
sought to understand it and to find peace within themselves. If they expressed any
positive feelings about those around them then it was generally a wish to be able to
function with friends and neighbours.66
SELF-THERAPY
Doctors conventionally advised attention to diet, healthful exercise, and moderation
in all things. In so doing, they catered to a shared belief that people had a responsibility
for their own health which could be realised through their own actions. In addition,
those who knew or were persuaded that they were physically or mentally ill might try
medical self-therapy. Taking medicine was itself fashionable, even when unnecessary.
The wife of John Halliday’s ploughman dismissed the idea that her husband’s employer
had been poisoned by his wife with the retort: ‘he was as well as ever he was although
he had too many drugs in him’.67 Charles Graeme dosed himself liberally with medicines
when he caught a ‘chill’ while on military service in North America, but nobody close
to him knew where they came from or what they were.68 The historian rarely knows
what was in the medicines unless they were common ones like laudanum or thought
to be worthless, as with the antidotes Duncan Campbell took against imaginary poisons.69
The use of opiates on lunatics is not well documented though Porter speculates that
narcotic painkillers were prevalent in late eighteenth-century England. Buchan advised
caution in the use of opiates ‘as these only palliate the symptoms’.70 Cullen also opined
that while opium alleviated mania he was uncertain if prolonged use would bring
about a cure.71
The most commonly mentioned ‘medicine’ was alcohol, both self-administered
and as part of a treatment regimen. The role of alcohol in producing temporary mood
and behaviour swings is mentioned in more than half of the cases of alleged furiosity
among men. It was the most potentially harmful and the most used psychotropic
substance in eighteenth-century Scotland and, in all likelihood, anywhere in early-
modern Europe. In the public asylums and better private madhouses of the early
nineteenth century strong drink was banned - as was gambling for money.72 Alcohol
was nevertheless part of many treatment programmes in Edinburgh Royal Infirmary
564 R. A. HOUSTON
and was vigorously advocated by followers of John Brown’s medical system in the
1780s.73
The administration of alcohol remained a part of the recorded treatment of men
throughout the century, though used as a sedative rather than a stimulant. Speaking of
Neil Campbell, an illiterate farmer recalled: ‘during the periods that the deponent was
employed in watching Dunstaffnage they were frequently in use to give him spirits
and sometimes he himself would take more than they were inclined to give him
though the deponent does not recollect that at any of these times Dunstaffnage took
what left him intoxicated’.74 After his removal from his seat at Dunfermline, James
Edwards was accommodated with the clerk to Edinburgh Charity Workhouse who
lived next to the Bedlam. A woman servant called Janet MacLeod told of Edwards’
craving for spirits, but added that if they were given to him they are mixed with water,
‘in so much that it can do him no harm’.75 Edwards was described by all around him
as dependent on alcohol.
MacLeod’s comment, and that of Campbell’s ploughman, refers to the physical
impact of large quantities of raw spirit. Neil Campbell started on whisky in the morning.
Some doctors and families recognised that mental derangement could originate from
excessive drinking but that did not prevent the continued use of alcohol as a ‘medicine’.
An Airdrie surgeon of the 1760s gave Joseph Howie ‘spirits’ to ease the pain of his
‘gravelish disorder...[which] he imputed...to proceed from a rising of the spleen or a
hypocondryacal distemper’.76 Alcohol was an analgesic; it palliated the worst fears and
delusions, and the most disruptive verbal abuse and physical violence of these men.
But it ultimately left them in the same state whether watered or neat, whether in the
guise of a patent medicine or as common whisky, rum, or brandy. A letter filed with
the admission papers for Mary Hinshaw from Hamilton warned the keepers of Glasgow
Asylum that when she left that place she had a bottle of laudanum and one of brandy
secreted about her.77 In the case of a young Stirling confectioner called John Raeburn
his friends reported that he had: ‘no lucid intervals except he gets a very little strong
ale; smokes a great deal, frequently 6 or 7 pipefuls of tobacco without stopping’.78
Compared with alcohol, and for all its contemporary fashionability and modern
connotations, opium was probably of lesser significance in the care of most ‘furious’
people in eighteenth and early nineteenth-century Scotland.
Some of the actions to which the mentally ill resorted were interpreted as signs of
mental derangement. However, sympathetic practitioners could see that there was a
purpose to their actions. The third report on Glasgow Asylum told of a young man
who tore his clothes and destroyed his mother’s furniture when he was sent home. He
refused to enter into a pact not to repeat this since ‘I may be again, as I have been
already, in such a state that nothing but breaking furniture can give me any ease.’79
Even if the root cause was delusional, the means taken to alleviate symptoms might
have a measure of rationality behind them. Going naked in public was a strong indicator
of insanity but the ‘furious’ could rationalise their actions. As Jean Blair ran away from
the house in Charles Street where she had murdered her mistress and set fire to the
curtains: ‘she threw off her shirt in the lane between Potterrow and Bristo Port and
her reason for doing so was that she thought there was an evil spirit following her’.80
Jean wanted to distract or ward off what she dreaded.
Standing back from contemporary interpretations or self-justifications, it is possible
to read into certain actions attempts at self-therapy. Nakedness might ease the
claustrophobic sensation of wearing clothes or provide a decoy for following spirits or
provide an escape for sufferers who thought their garments somehow poisoned or